Tuesday, October 02, 2012

Oral Appliances or CPAP, Which is Better?

The following is a guest blog post, see below this article for my thought on the issue:

Devices that provide CPAP, or continuous positive airway pressure, are often considered the “gold standard” of treatment for obstructive sleep apnea. After a sleep study is conducted and sleep apnea is diagnosed, a sleep specialist will typically prescribe CPAP machines and masks as the first line of treatment. Though the sleep disorder solution may be a blessing to many, others may find the device loud, restrictive and ineffective in getting them a better night’s rest. For patients who do not tolerate CPAP therapy, the American Academy of Sleep Medicine (AASM) has offered its recommendation for alternatives in the form of oral appliances.

In an issue of Sleep, researchers at the AASM released updated instructions for the treatment of obstructive sleep apnea with CPAP alternatives in an article entitled, “Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances.” Since the publication of these guidelines in 2006, patients diagnosed with mild to moderate sleep apnea have been able to take advantage of alternative devices. Physicians will prescribe the oral appliances to those who have already responded poorly to CPAP or to those who simply prefer another method. However, the AASM still advocates CPAP as the best form of treatment for patients with severe sleep apnea.

According to the AASM’s guidelines, the first step to treating sleep apnea of any severity is to have the sleep disorder diagnosed by a physician with ample experience in Sleep Medicine, particularly with sleep-disordered breathing. You can find certified sleep professionals in your area by searching local or online listings for sleep centers. To find a sleep dentist trained in oral appliances, experts such as Ira Shapira, DDS recommend that you find a sleep specialist that is a Diplomate of the Academy of Dental Sleep Medicine (ADSM).

If you have ever had to wear a mouth guard or an orthodontic retainer at night, you won’t have too much trouble adapting to an oral appliance for sleep apnea. The devices are designed to prevent the airway from collapsing while you sleep. This is most often achieved by moving your lower jaw, jaw muscles, uvula, soft palate, tongue or a combination of several of these parts.

The most common type of oral appliance is a mandibular repositioning device, which uses the upper jaw as an anchor to bring the lower jaw forward. In this position the walls of the pharynx and the tongue are also corrected. There are other oral appliances for sleep apnea available too, such as the tongue retaining device, which uses a suction mechanism to keep the tongue from falling backward and blocking the throat while you lie down.

In general, oral appliances have a higher compliance rate than CPAP in treating obstructive sleep apnea. Less than half of patients that are put on a CPAP treatment plan are actually able to continue the use of their machines and masks as recommended. And even these patients sometimes prefer oral appliances over CPAP because the oral devices are supposedly easier to use during travel and feel less distracting in shared bedrooms. Some oral devices, such as the Thornton Adjustable Positioner (TAP), have volume knobs that allow the patient to be more in control of sleep apnea treatment. Others, such as the Somnomed appliance, feature a straw through which you can drink water at night. In the end, the specific brand of oral appliance you use is not as important as keeping the upper airway unobstructed.

This is a guest blog post:

Sleepdisorders.com is designed to link sleep disorder sufferers to local sleep doctors and sleep centers. In addition to our directory of sleep doctors, you can find informational articles related to your unique sleep disorder.

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My thoughts: Oral appliances are a reasonable treatment option for mild to moderate OSA. CPAP remains the gold standard, especially for more severe forms of OSA. Oral appliances can be difficult to tolerate for some patients. In order to have success with an oral appliance, the involvement of a well-trained dental sleep specialist, working with a board-certified sleep doctor, is necessary. I do NOT recommend mail-order dental appliances.

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